Health IT Progress In Post-Acute Care Remains Slow

Nursing homes and other long-term care facilities need to beef up computerization to meet national healthcare goals, says federal report.

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Rehabilitation facilities, nursing homes and other long-term care providers are lagging their acute-care brethren in health IT, according to a new report from the Office of the National Coordinator for Health IT (ONC). Long-term and post-acute care (LTPAC) facilities need to catch up to other healthcare facilities' use of electronic health records and data exchange, for instance, if they are to fully play their part in meeting the national agenda of improving the quality and lowering the cost of healthcare, said the ONC in its issue brief, "Health IT in Long-Term and Post Acute Care."

The report notes that LTPAC providers are not eligible for the Meaningful Use incentives that have helped boost the use of EHRs among acute-care hospitals and ambulatory-care practices. Partly as a consequence, the use of EHRs in the LTPAC sector has lagged behind deployment in other healthcare sectors. Moreover, the systems in use are better suited to providing required reports to Medicare than to communicating with other providers' systems. Yet the ability of LTPAC providers to exchange data with providers that are eligible for incentives "is paramount to the continuity and quality of patient centered care," the report points out.

The stage 2 Meaningful Use requirements take an important step in this direction, the report says, by requiring hospitals and eligible professionals to exchange clinical summaries with other providers at transitions of care. Because many patients are discharged from hospitals to nursing homes, rehab facilities or home care, it's likely that providers will try to exchange data with the LTPAC providers if they can.

In addition, the brief points out, the Health IT Policy Committee and the Health IT Standards Committee both are considering "refinements related to transitions of care and care planning for Stage 3 Meaningful Use."

Some ideas that might be considered were discussed at a May 2012 LTPAC roundtable convened by ONC. Stakeholders at that meeting identified three priorities for LTPAC health IT that should be incorporated in the Meaningful Use criteria: person-centric longitudinal care plans, transitions of care, and federally required patient assessments.

A major obstacle to interoperability is the disconnect between the structure of LTPAC EHRs and that of EHRs certified for Meaningful Use. To date, the report notes, nine LTPAC vendors have obtained ONC-Authorized Testing and Certification Body (ATCB) modular certification, meaning that only parts of their systems are certified. Four other vendors have obtained 2011 LTPAC certification from the Certification Commission for Healthcare Information Technology (CCHIT). This certification shows that an EHR meets comprehensive functional, interoperability, and security criteria, but it is separate from ONC-ATCB certification.

One way to leapfrog the incompatibility issue, the report suggests, is for LTPAC providers to use the Direct secure messaging protocol that has gained some traction in health information exchanges. The Oklahoma Statewide HIE, for example, is using Direct to support transitions of care under a federal grant.

Although most of the information in the report was already public, there is one piece of news concerning new software conversion tools developed by Pennsylvania's Keystone Beacon Community, an ONC-funded entity led by the Geisinger Health System. The tools convert nursing home and home care Medicare reports into Continuity of Care Documents (CCDs). Announced last year, these tools include an application that converts the "minimum data set" (MDS) reports that nursing homes must submit monthly to the Centers for Medicare and Medicaid Services (CMS). The other application translates home care agencies' OASIS reports into CCDs, which are consumable by acute-care and ambulatory care EHRs.

According to the ONC issue brief, the Keystone Beacon Community has contracted with a vendor to host the tools as a Web service and plans to make the "low cost" Web-based service available to any U.S. nursing home, home health agency or health information exchange (HIE) in the second quarter of 2013.

For nursing homes, the prices for the new Web service range from $499 per year plus $40 per month for the smallest facilities to $899 per year plus $100 per 200 residents above 400 for the biggest ones. The pricing is similar for home care agencies but has an extra tier for large companies and refers specifically to the number of Medicare patients.

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